预防预致敏受者尸体肾移植术后急性排斥反应的临床研究

Prevention of acute rejection of renal allograft in sensitized recipients

目的探讨HLA配型及新型免疫抑制剂治疗方案对预防致敏患者肾移植术后急性排斥反应的影响。方法实验组选择46例术前致敏患者（术前PRA〉10％），对照组选择同期705例未致敏患者（术前PRA〈10％），实验组患者均采用诱导治疗（ATG100mg／d，5～7d）＋三联免疫抑制剂维持治疗方案（FK506＋MMF＋激素），比较两组间患者术后急性排斥反应发病率、移植肾功能延迟恢复比例、移植肾／患者一年存活率，同时分析HLA配型对移植肾急性排斥反应的影响。结果实验组与对照组急性排斥反应的发病率分别为30．43％和19．57％（P〈0．05）；移植肾功能延迟恢复发病率分别为60．86％和11．87％（P〈0．01）。患者一年存活率分别为95．65％和98．44％，一年移植肾存活率分别为93．48％和96．88％；一年时平均血肌肝分别为130mmol／dL和125mmol／dL，差异无统计学意义。实验组患者HLA相配率（4．2）明显高于对照组患者（2．8）（P〈0．05）。实验组中HLA配型24错配的患者与0-2错配患者的急性排斥反应发病率有显著性差异，高度致敏患者（移植术前PRA〉50％）急性排斥反应发病率较低度致敏患者（PRA10％～20％）发病率高，移植术后PRA水平持续升高者更容易出现急性排斥反应。结论供、受者之间良好的HLA配型及采用新型免疫抑制药物治疗方案，对预防及减轻致敏患者移植术后急性排斥反应疗效确切.

objective To evaluate the influence of HLA matching and new immunosuppressants on preventing acute rejection of renal allograft in sensitized recipients. Methods 751 recipients underwent renal transplantation were enrolled in this study including 46 sensitized recipients （ study group） with PRA between 10%- 90% and 705 non-sensitized recipients （control group） with PRA less than 10% pretransplant. All patients in the study group received induction course （ ATE 100 mg/d, 5-7 d） plus triple-immunosuppressive therapy including FK506 ＋ MMF ＋ steroid. The rate of acute rejection and delayed graft function after renal transplantation was analyzed. The influence of HLA matching on preventing acute rejection was also evaluated. Results The acute rejection rate in the study group and control group was 30.43% and 19. 57% , respectively, （ P 〈 0.05 ）. The rate of delayed graft function was 60.86% in the study group, significantly higher than that of the control group （ 11.87% ）. There was no statistically difference of one-year patient / graft survival rates between the two groups. The average serum creatinin levels at one-year posttransplantation were similar between the two groups （ 130 mmol/dl in the study group and 125 mmol/dl in the control group）. The average loci of HLA matching in the study group （4.2） was significantly higher than that in the control group （2.8）. The acute rejection rate in the study group was significantly higher when loei of HLA mismatch ranging from 2- 4 compared with loci of HLA mismatch less than 2. The acute rejection rate was significantly higher in the highly sensitized recipients （ PRA ranging from 50% -90% pretransplant） than that in the less sensitized （PRA ranging from 10% to 20% pretransplant） in the study group. Patients with higher PRA level posttransplantation were prone to developing acute rejection HLA matching and new immunosuppressants can reduce the incidence of acute rejection ents and increase the survival rate of patients and allografts. Conclusion Good in sensitized recipients and increase the survival rate of patients and allografts.